XIAP、XAF1、TNF-α在子宫内膜异位症发病机制中的作用

Effect of XIAP,XAF1 and TNF-α in endometriosis

目的:探讨X染色体连锁凋亡抑制蛋白(XIAP)及相关因子1(XAF1)和肿瘤坏死因子-α(TNF-α)在子宫内膜异位症(EMT)发病机制中的作用。方法:2007年6月～2008年4月行腹腔镜下子宫内膜异位囊肿剥除术患者65例(研究组),同期因输卵管因素不孕行腹腔镜手术治疗的患者55例(对照组),均刮取子宫内膜,利用流式细胞仪检测细胞凋亡率;免疫组化检测在位及异位子宫内膜组织中XIAP和XAF1的表达;ELISA检测两组患者腹水中TNF-α浓度。结果:①对照组分泌期细胞凋亡率(7.38±0.76%)高于增生期(4.66±1.14%)(P<0.05);研究组在位和异位内膜增生期与分泌期细胞凋亡率均无周期变化,异位内膜低于在位内膜(P<0.05),在位内膜低于正常内膜(P<0.05)。②对照组和研究组在位内膜中XIAP的表达,增生期均高于分泌期(P<0.05),在研究组异位内膜中表达无周期变化。③XAF1的表达,对照组和研究组在位内膜组织中分泌期XAF1表达高于增生期(P<0.05),研究组异位内膜增生期和分泌期XAF1的表达无差异(P>0.05)。④研究组和对照组增生期与分泌期腹水中TNF-α浓度无差异(P>0.05),研究组高于对照组(P<0.05)。⑤XIAP与XAF1表达呈负相关,XAF1的表达与TNF-α水平呈正相关(P<0.05)。结论:在EMT中凋亡抑制因子表达增强,凋亡促进因子表达减弱,可能对异位内膜种植起促进作用,但TNF-α水平升高通过增强XAF1活性,在一定程度上限制了异位内膜的无限制生长,使其表现为良性疾病。

Objective ： To explore the role of X - linked inhibitor of apoptosis protein （XIAP） , XIAP Associated Factor 1 （ XAF1 ） and tumor necrosis factor alpha （ TNF - α） in the pathogenesis of endometriosis （EMT）. Methods ： From June 2007 to April 2008, 65 women who underwent excision of endometriotie ovarian cysts with laparoscopy （ the study group） and 55 tubal infertility patients who underwent laparoscopy （the control group） were recruited. The cell apoptosis rate was measured with flow cytometry. The expressions of XIAP and XAF1 in eutopic and ectopic endometria were evaluated with immunohisto-chemical analysis. The concentration of TNF - α in the peritoneal fluid was measured by ELISA. Results ： The apoptosis rate in the secretory phase （7.38 ±0.76% ） was higher than that of the follicular phase （4.66 ± 1.14% ） in the control group （P 〈 0.05 ）. And there was no significant difference in the apoptosis rate of eutopic endometria between the secretory and follicu-lar phases, so as that of ectopic endometria （ P all 〉 0.05 ）. The apoptosis rate in the eetopic endometrium was lower than that of the eutopic endometrium, and the latter was lower than that of the control （ P all 〈 0.05 ）. The expression of XIAP during the follicular phase was higher than those of the secretory phase in the eutopie and control endometria （ P 〈 0.05 ）. But there was no significant difference in the expression of XIAP of the ectopie endometrium between the secretory and follicular phases （ P 〉0. 05 ）. The expression of XAF1 during the secretory phase was higher than those of the follicular phase in the eu-topic and control endometria （ P 〈 0. 05 ）. But there was no significant difference in the expression of XAF1 of the ectopic en-dometrium between the secretory and follicular phases （ P 〉 0. 05 ）. Whether in the study group or the control group, there was no significant difference in the concentration of TNF - α between the follicular and secretory phases （P 〉 0.05 ）. While the concentration of TNF - α in the study group was higher than that in the control group （P 〈 0.05 ）. The positive correlation between expressions of XIAP and XAF1 and the negative one between the expression of XAF1 and the concentration of TNF - α were found. Conclusion ： The increased expression of the apoptosis promoter and decreased expression of the apoptosis inhib- itor maybe benefit for local and distant metastasis of ectopic endometrium. While high concentration of TNF - α could restrict the growth of ectopic endometrium by enhancing the expression of XAF1.